Key result
Phenylephrine and ephedrine were similarly effective in preventing hypotension during elective cesarean section under spinal anesthesia, with 65% of phenylephrine patients and 61.7% of ephedrine patients experiencing one or more hypotension episodes.
Why the study?
Maternal haemodynamic variations are common during caesarean section under spinal anesthesia, and this study compared the effectiveness of phenylephrine versus ephedrine in preventing and treating hypotension and their fetal outcomes.
Does ephedrine compared to phenylephrine prevent hypotension and improve neonatal outcomes in pregnant women undergoing cesarean section under spinal anesthesia?
RCT (n=120)
Double-blind
Randomized equally into 2 groups
No
Does ephedrine compared to phenylephrine prevent hypotension and improve neonatal outcomes in pregnant women undergoing cesarean section under spinal anesthesia?
Ephedrine and phenylephrine are equally effective in preventing and treating hypotension during spinal anesthesia for cesarean section, with no significant difference in fetal acidosis, though phenylephrine causes more bradycardia.
Answers are grounded in this paper and cite their sources.
Either agent suits spinal hypotension management in cesarean delivery; confirms equivalent neonatal safety with phenylephrine-linked bradycardia.
Maternal haemodynamic variations are communal during caesarean section by spinal anesthesia. Several measures are adopted to treat hypotension. The aim of this study is to compare the effectiveness of phenylephrine and ephedrine in treating and preventing hypotension during C-section by spinal anesthesia and its outcome on the condition of the fetus. Place and Duration: In the Anesthesia department of Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six-months duration from July 2021 to December 2021. Methods: 120 total ASA grade-I patients with normal single pregnancy over 36 weeks who endured planned caesarean-section under spinal-anesthesia were randomized into 2 groups equally. Group I was given 5 mg rescue bolus and 10 mg prophylactic bolus dose of ephedrine intravenously during intrathecal block. Group II received 50 µg of rescue bolus and 100 µg of an intravenous dose of prophylactic phenylephrine bolus during intrathecal block. Haemodynamic variables such as heart rate and blood pressure were documented after every-2-mints until birth and every 5-minutes thereafter. The neonatal score was measured using the 1- and 5-minute Apgar scale and the pH value of the neonatal blood in the umbilical cord. Results: There were no differences in the treatment of hypotension among the 2 groups. The bradycardia incidence was greater in the group of phenylephrine. The variances in Apgar score, birth weight and umbilical cord pH amid the 2 groups were not statistically significant. Conclusions: Ephedrine and phenylephrine are similarly operative in the treatment of hypotension during elective caesarean section given spinal anesthesia. No statical variance in the occurrence of true fetal acidosis between the two vasopressors was noticed. Both groups have good neonatal outcome.
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Chaudhry et al. (2022) conducted an RCT in Hypotension during Cesarean Section under Spinal Anesthesia (n=120). Phenylephrine vs. Ephedrine (10 mg prophylactic bolus and 5 mg rescue bolus IV) was evaluated on Incidence of one or more hypotension episodes requiring rescue vasopressor (p=>0.05). Phenylephrine and ephedrine were similarly effective in preventing hypotension during elective cesarean section under spinal anesthesia, with 65% of phenylephrine patients and 61.7% of ephedrine patients experiencing one or more hypotension episodes.
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